Provider Demographics
NPI:1669510806
Name:WEISSMAN, CAROL ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:SACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 SCHENCK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3600
Mailing Address - Country:US
Mailing Address - Phone:516-268-0681
Mailing Address - Fax:
Practice Address - Street 1:5 SCHENCK AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3600
Practice Address - Country:US
Practice Address - Phone:516-268-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0092731103T00000X
FLPY5650103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0953OtherMEDICARE PTAN